Department of Family and Community Medicine, University of California, San Francisco, USA.
Ann Fam Med. 2011 Mar-Apr;9(2):148-54. doi: 10.1370/afm.1224.
Mutual trust is an important aspect of the patient-physician relationship with positive consequences for both parties. Previous measures have been limited to patient trust in the physician. We set out to develop and validate a measure of physician trust in the patient.
We identified candidate items for the scale by content analysis of a previous qualitative study of patient-physician trust and developed and validated a scale among 61 primary care clinicians (50 physicians and 11 nonphysicians) with respect to 168 patients as part of a community-based study of prescription opioid use for chronic, nonmalignant pain in HIV-positive adults. Polychoric factor structure analysis using the Pratt D matrix was used to reduce the number of items and describe the factor structure. Construct validity was tested by comparing mean clinician trust scores for patients by clinician and patient behaviors expected to be associated with clinician trust using a generalized linear mixed model.
The final 12-item scale had high internal reliability (Cronbach α =.93) and a distinct 2-factor pattern with the Pratt matrix D. Construct validity was demonstrated with respect to clinician-reported self-behaviors including toxicology screening (P <.001), and refusal to prescribe opioids (P <.001) and with patient behaviors including reporting opioids lost or stolen (P=.008), taking opioids to get high (P <.001), and selling opioids (P<.001).
If validated in other populations, this measure of physician trust in the patient will be useful in investigating the antecedents and consequences of mutual trust, and the relationship between mutual trust and processes of care, which can help improve the delivery of clinical care.
相互信任是医患关系的一个重要方面，对医患双方都有积极的影响。之前的衡量标准仅限于患者对医生的信任。我们旨在开发和验证一种衡量医生对患者信任的方法。
我们通过对先前关于医患信任的定性研究的内容分析，确定了该量表的候选项目，并在一项基于社区的艾滋病毒阳性成年人慢性非恶性疼痛处方类阿片使用研究中，针对 168 名患者，由 61 名初级保健临床医生（50 名医生和 11 名非医生）对该量表进行了开发和验证。使用 Pratt D 矩阵进行多角因子结构分析，以减少项目数量并描述因子结构。通过比较与医生信任相关的医生和患者行为的平均临床医生信任评分，使用广义线性混合模型来测试构念效度。
最终的 12 项量表具有较高的内部可靠性（Cronbach α=.93），并且具有明显的 Pratt 矩阵 D 的两因素模式。根据医生报告的自我行为（包括毒理学筛查（P <.001）和拒绝开阿片类药物（P <.001））和患者行为（包括报告丢失或被盗的阿片类药物（P=.008）、为了获得快感而服用阿片类药物（P <.001）和出售阿片类药物（P<.001）），证明了构念效度。
如果在其他人群中得到验证，这种衡量医生对患者信任的方法将有助于研究相互信任的前因后果，以及相互信任与护理过程之间的关系，这有助于改善临床护理的提供。
